Week in Zahedan - Day 5: The twins

Day 5 – The twins

Today when I arrived at Shirabad clinic, I saw a mother waving to me with a baby in her arms, so I went to see her. I recognised her as the mother of premature twins I had visited when I first arrived in Zahedan. I remember her well I was home visiting in the community, when the home visitor asked us to visit a mother who had had twins. When we arrived at her house, we found two very small babies, who were having trouble feeding; the mother had no milk supply. When I examined the twins, the first one was small (less than 2500 grams) but not doing too badly another than being small. The second twin, as I opened the cloth he was wrapped in I found a very small, yellow baby, who was sick and so scrawny he was developing pressure areas on his hips and back.

I just said to the mother we need to go to our clinic as the baby needs to be admitted to hospital. Then I noticed the mother wasn’t very interactive, when I examined her she had a high fever and pneumonia (no wonder she was not very interactive, she didn’t have the energy), so we bundled up the family and arranged for them to come to our clinic. The mother was given treatment for her pneumonia and the smallest twin was sent straight to hospital with sepsis (infection). We then arranged for the mother to attend MOH to receive milk (they provide this service) as she had no milk supply to feed her babies. He mother returned the next day and told us she had been sent away from MOH, so I sent one of our home visitors back with her and she was able to receive some formula. We have been following the babies every week in our clinics since then and supplementing the supply of milk from MOH (as they are not providing enough for the twins).

Today she was here as the second twin was again sick, however looking at both of them and I hadn’t seen them both for a while and they were certainly looking much better than the first time I met them. It is funny now that I have been here a while, when I arrive at the clinic I get a wave and a smile form someone you have helped along the way, which is kind of nice.

Week in Zahedan: Day 3- New arrivals from Afghanistan

Day 3- New arrivals from Afghanistan
Today I have been asked to a visit to one of the outlying areas of Zahedan by the home visitors as there is a couple of pregnant ladies who have been unable to attend our clinic due to fear of crossing the checkpoint. So we headed off with one home visitor and my translator.

When we arrived in the area, we visited the first family where I visited a woman who was 7 months pregnant, so performed an antenatal check on her; a relative came in who had had her baby at home days earlier so I then examined her and her baby who was doing well. We then went to visit the second woman who was 4 months pregnant and had not received any antenatal care, so we also visited her.

One of the older ladies there asked if I could check her blood pressure (which was quite high), so I find out she was diabetic and had high blood pressure but couldn’t get into our clinic to receive medication. Whilst talking with the families we found out that it is getting difficult for them to come into town to our clinics due to fear of being arrested when crossing through the checkpoint. We were then told about a new family who had just arrived in Iran, so we went to visit them to assess their situation.

When we arrived at the house they are staying in we knocked with no answer, eventually a neighbour told us that the woman was home on her own and was too scared to come to the door, in case we were from the police. He explained over her fence who we were and why we had come to see her, so she came to let us in. When we saw her house I was glad we came to see her as there were 10 people living in these 2 rooms, with no window or doors to keep the cold out and very thin cover for the floor( which didn’t do much), they had no money and no cooking utensils, nothing really. I found a well in the front yard, the lady explained that they buy the bore water (not potable) which also had rubbish floating in it, which was there water supply for washing and cooking and drinking. So we explained about preparing the water to make it safer to use and explained that we would be able to return in the next couple of days to distribute some supplies of food (lentils, oil etc) and some non food items such as blankets, hygiene
items, some basic cooking utensils and some jerry cans to keep safe water to drink in. All in all not a bad day we saw 15 patients who were unable to attend medical care.

It is now three weeks after our first visit, this is our second visit to the area, after identifying the need on our first visit three weeks ago. Now we are better prepared also, we have come with me a nurse/midwife, a doctor, home visitor, my translator and our own vehicle and driver. This means we have bought supplies of equipment, drugs and some kits with hygiene items to distribute.

Our last visit we saw many patients going house to house through word of mouth to visit people who complained of having their husbands arrested, or now being just too scared to try and come through the checkpoints.

We started off by visiting some new comers from Afghanistan who had arrived 10 days ago. Whilst we were visiting these families, we had others come to the house to say they had someone who needed to see the doctor or midwife. So pretty soon we had visited three houses and seen a mixture of people from a young 12 year old girl (newly married) who I performed her first antenatal visit on to adults with high blood pressure and range of complaints in between. As word was staring to get around about the medical team visiting, whilst we were visiting some patients in the next house, I turned around to see the room full of people lining up to visit the doctor or the midwife. So I decided to get the gear out of the car and we set up for the rest of the morning in the room of one the families living in this house. I managed to distribute all the hygiene kits to the new mothers I saw that day. These kits contain some items to assist with hygiene, which is important for new mothers and babies who are more vulnerable to succumb from infections in this first few week post delivery of the baby. The kits contained a bowl (to wash baby and clothing), some sanitary napkins, nappies, soap, towel, toothbrush etc).After a while we had a queue of men also, which was surprising ( we don’t often see a lot of men in our clinics or at home when we visit,( as they try and get daily work so  they are working),at the moment it is harder for them to pass through the checkpoints( due to the risk of being arrested), so there were a lot around at home today, it was great that we were able to visit them and provide some access to health care for them.

By the time we headed back home we had visited nearly 40 patients, our home visitors had also assessed the living conditions of these new comers and would arrange a distribution of food and non food items, to help tide them through this initial period, until they can maybe find some sort of income. The patients who needed medication we did not have with us, we arranged one of the home visitors to collect the medication and bring it back out to them.

Mehran - our first patient

Hello dear friends,

This is Ali

This is Ali

TOMORROW IS A great day for him and for the team of Medecins Sans Frontieres in Mehran, Iran. As part of the MSF package of programs for surgical treatment of Iraqi war victims, we will do our first elective operation tomorrow, and Ali will be our first patient.

HE IS 25 years old and this is his story:

ALI LIVES IN Baghdad. Four years ago he was driving through the city to take his sick brother to hospital. His mother and his pregnant sister were with them in the car. As they reached an American check-point, the soldiers opened fire without warning. Ali’s mother and his sister died immediately. His brother survived a gunshot wound to the head but he is now blind. Ali himself received a gunshot to his femur just above the knee. This fracture is healed now, but he can only bend his knee 30 degrees. He is in constant pain when walking. He can only walk 200 yards and he is unable to work.

WHEN ALI CAME home from hospital, an American general appeared at his house and apologized for the incident. He said that Ali’s family had been shot accidentally.

TOMORROW (12.04.08) I will operate on Ali. He is convinced that it will bring him strength if as many people as possible think about him at this time; and I believe that as many people as possible should know his story.

NOW YOU KNOW.

Dr Michael Rosck
Orthopaedic Surgeon
Mehran, MSF

PS
12.04.08 - 21.30 ALI’S OPERATION WENT well and we hope that he will make good progress post-operatively